美国放射科住院医师分阶段目标胜任力评价系统解读与思考（五）：儿科放射学分阶段目标胜任力评价系统

【摘要】儿科放射学分阶段目标胜任力评价系统（Pediatric Radiology Milestone Project,PRMP）由美国毕业后医学教育认证委员会（Accreditation Council for Graduate Medical Education,ACGME）与美国放射学会（American Board of Radiology,ABR）联合发布,是放射学住院医师儿科亚专业方向培训考核系统的一部分,该考核评价体系考核并记录放射学住院医师在儿科亚专业方向培训过程中所必须具备的六项胜任力,包括病患关切（Patient Care,PC）、医学知识（Medical Knowledge,MK）、基于系统的实践（Systems based Practice,SBP）、基于实践的学习（Practice based Learning,PBL）、职业素养（Professionalism,PROF）以及人际关系和沟通技巧（Interpersonal and Communication Skills,ICS）。考核内容全方位展示了美国放射学住院医师儿科亚专业方向胜任力培训的要点,值得国内住院医师培训机构学习和借鉴,对于完善国内培训机构考核方式及内容具有重要的指导价值。     

美国放射科住院医师分阶段目标胜任力评价系统解读与思考（二）——介入放射学分阶段目标胜任力评价系统

【摘要】介入放射学分阶段目标胜任力评价系统是由美国毕业后医学教育认证委员会（ACGME）与美国放射学会（ABR）联合倡议的用于评价放射学住院医师培训考核系统的一部分，该系统可以全方位、阶段性准确考核并记录放射学住院医师介入放射方面的培养成长过程，包括病患关切（PC）、医学知识（MK）、基于系统的实践（SBP）、基于实践的学习（PBL）、职业素养（PROF）、人际沟通技巧（ICS）共六大项目，二十个单项。考核内容全方位展示了美国住院医师胜任力培训的要点，值得国内住培机构学习借鉴；其培训过程中注重的而被国内所忽视的人文知识、职业素养、人际沟通、医疗质控的参与、卫生经济学等，都是我国住院医师规范化培训，甚至医学院校课程设置须着重发展完善的胜任力培训内容。     

美国放射科住院医师胜任力评价系统解读与思考(七):核医学Milestone胜任力评价系统

【摘要】核医学分阶段目标胜任力评价系统，是由美国毕业后医学教育认证委员会（ACGME）与美国核医学会（ABNM）联合倡议发起的用于评价核医学专科医师培训考核系统的一部分，该考核评价体系考核并记录核医学专科医师在培训过程中所须具备六项胜任力，包括病患照护（PC），医学知识（MK），基于系统的实践（SBP），基于实践的学习（PBL），职业素养（PROF），人际沟通技巧（ICS）。核医学分阶段目标胜任力评价系统为核医学科住院医师的规范化培训提供了统一的培养框架，对我国核医学科住院医师规范化培训和评价提供了新的借鉴和启示。     

美国放射科住院医师分阶段目标胜任力评价系统解读与思考（一）:放射诊断学分阶段目标胜任力评价系统

【摘要】基于胜任能力的医学人才培养已成为全球医学教育的发展趋势。美国毕业后医学教育认证委员会（ACGME）联合美国放射学委员会（ABR）发布了放射科住院医师或专科医师的分阶段目标胜任力评价系统,其主要目的是对参加ACGME认可的放射科医师培训项目的完成情况进行评估,为放射科住院医师或某个亚专业专科医师核心胜任力的发展提供了一个评估框架。在此仅介绍放射诊断学分阶段胜任力评价系统的主要内容、评价表主要结构及使用方法。美国放射科医师胜任力评价系统为放射科医师的规范化培训提供了统一的培养框架,能够实现过程控制与结果评价相结合、自我评价与他人评价相结合,使评价更加客观、全面,对我国放射科住院医师规范化培训和评价提供了新的借鉴和启示。     

美国放射科住院医师胜任力评价系统解读与思考（四）：腹部放射学Milestone

【摘要】腹部放射学分阶段目标胜任力评价系统（The Abdominal Radiology Milestone Project）,是由美国毕业后医学教育认证委员会（The Accreditation Council for Graduate Medical Education,ACGME）与美国放射学会（The American Board of Radiology,ABR）联合倡议发起的用于评价放射学专科医师培训考核系统的一部分,该考核评价体系考核并记录腹部放射学专科医师在培训过程中所须具备六项胜任力,包括病患关切（Patient Care,PC）,医学知识（Medical Knowledge,MK）,基于系统的实践（Systems based Practice,SBP）,基于实践的学习（Practice based Learning,PBL）、职业素养（Professionalism,PROF）,人际关系和沟通技巧（Interpersonal and Communication Skills,ICS）。另外,评价系统指出了多种放射亚专业评估工具,对于完善国内培训机构考核方式与内容,有着积极的指导价值。     

以岗位胜任力为导向的绩效考核在影像学住院医师培训中的应用

目的 探讨以岗位胜任力为导向的绩效考核在医学影像学住院医师规范化培训中的应用。方法 选取2019、2020、2021三个年级月度考核、年度考核以及2017、2018年级结业考试成绩，分别作为A组和B组，A组则以岗位胜任力为导向的绩效考核，比较考核成绩，B组为原有考核方式。结果 A组成绩优于B组，差异有统计学意义(P<0.05)。结论 以岗位胜任力为导向的绩效考核提高了医学影像学住院医师的综合能力，为培养更多合格乃至优秀的影像学住院医师奠定了良好的基石。     

院级督导在住院医师规范化培训中的效果评价

目的通过对新疆生产建设兵团某医院的住院医师规范化培训进行调查,研究分析该医院院级督导效果评价,以期为新疆地区住培基地院级督导顶层设计提供合理有效的参考依据与理论支撑。方法以问卷星第三方平台开展网络问卷调查的形式,随机抽取该医院专业基地内的部分住培医师和带教老师为研究对象,通过Excel和SPSS 25.0进行数据整理和统计学分析,计量资料以（均数±标准差）表示,组间比较采用单因素方差分析,以P<0.05为差异具有统计学意义。结果带教师资岗位胜任力评价中,带教师资专业知识、教学能力和职业素养,年度间比较发现,2020年度及2021年度各维度得分比2019年度高。住院医师核心胜任力评价中,住院医师的职业素养（F=21.631,P<0.05）、知识能力（F=23.704,P<0.05）、沟通合作（F=28.138,P<0.05）、终生学习（F=14.692,P<0.05）在年度间比较,差异均具有统计学意义,随着时间的延长,住院医师的核心胜任力提高。住院医师年度考核结果显示,2019年住院医师的年度考核通过率为37.80%,2021年年度考核通过率为61.01%。...     

机动卫勤分队特诊模块岗位胜任力评价指标体系构建

 目的 构建科学、系统、实用的机动卫勤分队特诊模块岗位胜任力评价指标体系,为训练和考评提供参考。方法 结合胜任力特征理论,通过文献分析法和小组访谈法初步拟定机动卫勤分队特诊模块岗位胜任力指标体系框架,采用德尔菲专家咨询法对21名专家进行2轮咨询,确定各级指标及权重分值,构建机动卫勤分队特诊模块岗位胜任力评价指标体系。结果 两轮咨询的有效回收率分别为95.2%、100%,两轮咨询的专家的权威程度为0.87、0.90,一、二级指标的重要性赋值均大于4.0,变异系数0.0382~0.1280,咨询专家积极性、权威程度及可信度高。构建的机动卫勤分队特诊模块岗位胜任力评价指标体系涵盖一级指标6项,二级指标49项。结论 本研究构建的机动卫勤分队特诊模块岗位胜任力评价指标体系具有较好的科学性、系统性和实用性。     

从专培到住培:美国介入放射学培训变革及其启示北大核心CSCD

我国介入放射学培训体系亟待建立。为适应临床需求、培养出更优秀的介入放射学医师,自2015年起,美国介入放射学培训由专科医师培训转变为医学院毕业后可以直接进入的住院医师培训模式,有IR/DR整合培训和独立IR培训两种路径。这种住培模式自实施以来,提高了学科吸引力。本文介绍了美国介入放射学培训体系衍变过程,现行培训模式、培训内容与要求,以及培训效果等内容,为我国探索建立介入放射学培训体系提供借鉴。     

以岗位胜任力为导向的新入职护士岗前培训效果观察

目的：探讨以岗位胜任力为导向的新入职护士岗前培训效果。方法选择新入职护士97人作为研究对象。将2011～2012年新入职的45名护士设为对照组,采用传统岗前培训模式。2013～2014年新入职的52名护士设为观察组,采用以岗位胜任力为导向的岗前培训模式。比较两组新入职护士的岗位胜任力。结果观察组护理基本理论和技能成绩、护理核心制度和卫生法律法规知晓程度、职业素质以及综合能力评分均明显高于对照组,差异有统计学意义（ P＜0.05或P＜0.01）。观察组岗位胜任力综合评分显著高于对照组,差异有统计学意义（ P＜0.01）。结论以岗位胜任力为导向的岗前培训能有效提高新入职护士岗位胜任力,对深入开展优质护理服务有着积极的促进作用。     

Differences in Neuroradiology Training Programs around the World

BACKGROUND AND PURPOSE:No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites.MATERIALS AND METHODS:Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies.RESULTS:While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%).CONCLUSIONS:There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally.

The United States considers itself a leader in medical education and training among nations.¹ Generally speaking, American medical school, residency, and fellowship programs are considered globally as being well-structured, highly competitive, and outstanding in the quality of education and instruction. As of the 2013–2014 academic year, 185 radiology residency programs and 85 neuroradiology (NR) fellowship programs in the United States are voluntarily supervised by the Accreditation Council for Graduate Medical Education (ACGME). This private, nonprofit organization sets educational standards and periodically reviews their implementation within the respective graduate medical education programs.² In addition, completion of programs accredited by the ACGME is a prerequisite to becoming board-certified in diagnostic radiology and subspecialty certified in neuroradiology. Examinations are offered by the American Board of Radiology annually through the American Board of Medical Specialties. It oversees specialty and subspecialty certification in radiology and 23 other medical specialties in the United States.The educational path for an aspiring American neuroradiologist typically begins by matching in a first-postgraduate-year prerequisite clinical year (internship year) and an ACGME-accredited postgraduate year 2- to 5-year diagnostic radiology residency program.³ The first 3 years of residency focus on diagnostic radiology (postgraduate years 2–4) and include 9 core rotations in abdominal radiology, breast imaging, cardiothoracic radiology, musculoskeletal radiology, neuroradiology, nuclear radiology, pediatric radiology, sonography, and vascular and interventional radiology. In postgraduate year 5, residents may participate in subspecialty rotations of their choice.⁴ The trainees'' diagnostic experience in the different imaging modalities is assessed through a case/procedure log system, which is annually reviewed by the faculty of the program and the ACGME.⁵After finishing residency, graduating radiologists have the opportunity to start additional fellowship training within their discipline of choice if they desire subspecialty expertise.⁶ Contributing factors that promote the implementation of fellowship programs in radiology are the rapid development of new imaging techniques, the need for appropriate interpretation skills and expertise to compete in the job market, and the trend toward endovascular and percutaneous therapies.¹The first NR fellowship positions were offered in Stockholm and London in the 1950s and approximately 10 years later in New York (1960).⁷ Regarding neuroradiology, 2 fellowships are offered in the United States currently: diagnostic neuroradiology (DNR) and interventional neuroradiology (INR), with the latter, by ACGME regulations, requiring a previous DNR year. However, very few of the offered neurointerventional programs are currently ACGME-accredited, so this requirement is often not completed.Because there is a trend toward greater subspecialization in radiology globally, we conducted a survey to investigate differences in radiology training programs across the world with regard to the general curriculum, focusing on neuroradiology fellowships in particular. Therefore, departments in countries on all continents were asked to complete a standardized questionnaire about their training programs. Hence, differences in international educational structures could be revealed.     

Factors affecting attending agreement with resident early readings of computed tomography and magnetic resonance imaging of the head, neck, and spine

RATIONALE AND OBJECTIVES: This study examines the joint effect of several factors on radiology resident performance in the task of interpreting after-hours neuroradiology examinations. MATERIALS AND METHODS: As part of a quality assessment process, we conducted a prospective evaluation of all (N = 21,796) after-hours preliminary readings of neuroradiology examinations performed by radiology residents over a 62-month period at our academic medical center. Each reading was scored by the interpreting neuroradiologist as "agree," "disagree with minimal clinical impact," and "disagree with significant clinical impact." Coded resident and attending identities were also recorded for each case along with modality, body area studied, and the date of examination. These raw data were used to create an analytic data set with level of resident/attending agreement as the outcome and six predictors, including two date-derived variables: months 1-62 representing when the case occurred during the study and quartiles 1-4 accounting for the timing of the case in each resident's own experience. Cross tabulations, plots, bivariate statistics, and logistic regression were used to examine the relationships between study variables and the outcome (level of agreement). RESULTS: Over about 5 years of the study, the absolute number of significant disagreements remained stable at about three per month. The total caseload increased at a rate of 4.1 per month with most of the increase falling into the agree category, whereas the minimal disagreements actually decreased slightly (0.2 per month). In the logistic model for disagreement, three of the factors accounted for most of the variance: attending (61%), resident (15%), and month (15%). Study type (modality and area examined) accounted for another 10%. There was no significant contribution from the variable (quartile) constructed to test for individual resident learning during the on-call experience. CONCLUSION: Although residents differ somewhat in the extent of attending agreement with their on-call work, evaluation or remediation made on the basis of simple comparison of these rates should be done with caution. Improved agreement over time seems to be a collective experience shared by residents.     

Sonography and neurodiagnosis (neurosonography)

Sonography is a necessary part of neuroradiology. Its relative importance will increase as the sonographic images improve and the funds provided for diagnostic imaging decrease. We urge the incorporation of neurosonographic training into our neuroradiology fellowship programs and more widespread use of sonography in neurodiagnosis.     

Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies

RATIONALE AND OBJECTIVES: To determine the incidence of radiology resident preliminary interpretation errors for plain film, body computed tomography, and neuroradiology (neuro)computed tomographic examinations read on call. MATERIALS AND METHODS: We retrospectively reviewed the data in a prospectively acquired resident quality assurance (QA) database dating between January 2000 and March 2007. The database comprises all imaging studies initially interpreted by an on-call resident and later reviewed by a board-certified attending radiologist who determined the level of discrepancy between the two interpretations according to a graded scale from 0 (no discrepancy) to 3 (major discrepancy). We reviewed the data with respect to resident training level, imaging modality, and variance level. Statistical analysis was performed with chi(2) test, alpha = 0.05. We compared our results with other published series studying resident and attending accuracy. RESULTS: A total of 141,381 cases were entered into the database during the review period. Of all examinations, 95.7% had zero variance, 3.3% minor variance, and 1.0% major variance. There was a slight, statistically significant increase in overall accuracy with increased resident year from 95.4% of examinations read by first-year residents (R1s) to 96.1% by fourth-year resident (R4s) (P < .0001). Overall percentages of exams with major discrepancies were 1.0% for R1s, 1.1% for second-year residents, 1.0% for third-year residents, and 0.98% for R4s. CONCLUSIONS: The majority of preliminary resident interpretations are highly accurate. The incidence of major discrepancies is extremely low and similar, even with R1s, to that of attending radiologists published in other studies. A slight, statistically significant decrease in the error rate is detectable as residents gain experience throughout the 4 years of residency.     

Effect of training and experience on qualitative and quantitative CT perfusion data

BACKGROUND AND PURPOSE: To evaluate interobserver reliability of obtaining CT perfusion (CTP) data for qualitative identification of perfusion abnormality and quantitative assessment through regions-of-interest (ROIs) placement. MATERIALS AND METHODS: Six observers participated in the study (neuroradiology attending physician, neurology attending physician, neuroradiology fellow, radiology resident physician, senior and junior CT technologists). After a brief training session, each observer evaluated 20 CTP datasets for qualitative identification of a right- or left-sided perfusion abnormality or symmetric perfusion. Observers also placed a single ROI of standard size to obtain quantitative data on the most severely hypoperfused region. An additional 10 ROIs were placed on the cortex to quantitatively evaluate global cortical perfusion. Mean quantitative cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) values were analyzed. RESULTS: The kappa values for qualitative assessment of a perfusion abnormality ranged from 0.55 to 1.0. Coefficients of variation for quantitative assessment of ischemia/infarct region were 27.10% for CBF, 13.33% for CBV, and 4.66% for MTT. Coefficients of variation for quantitative assessment of global cortical perfusion were 11.88% for CBF, 13.66% for CBV, and 3.55% for MTT. The junior CT technologist and neuroradiology fellow showed significant differences compared with other observers for the ischemia/infarct region and global cortical perfusion, respectively. CONCLUSION: Overall, quantitative differences seen in this study would not necessarily affect quality of interpretation of ischemia/infarct region or global cortical perfusion. Therefore, obtaining qualitative and quantitative CTP data can reliably be performed in the clinical setting among observers with various levels of skill and experience when using a uniform and standard technique.     

Disease, level of impact, and quality of research methods. Three dimensions of clinical efficacy assessment applied to magnetic resonance imaging.

Assessment of the clinical efficacy of diagnostic imaging technologies frequently involves reviews of published research. Reports may be classified in three dimensions; by disease, by type of assessment, and by the quality of research methods. The disease dimension describes the condition or conditions shown by an imaging technique. The assessment dimension spans five levels: technical capacity, diagnostic accuracy, diagnostic impacts, therapeutic impacts, and patient outcome impacts. The methods quality dimension can be expressed as four levels: excellent, good, fair or poor. An important interaction exists: the level of efficacy addressed by a research project dictates which methodologic procedures are important. For example, randomization is important only when a research report addresses the levels of therapeutic and patient outcome impacts. The authors suggest that classification of studies according to the three preceding dimensions maps the breadth (across diseases), depth (across levels of clinical efficacy), and quality of the assessment of complex imaging technologies. Such a map should help participants in technology assessment define the progress they have made. The classification strategy as applied to the clinical efficacy assessment of magnetic resonance imaging (MRI) for neuroradiology is illustrated.     

Fellowship and practice trends in neuroradiology training programs in the United States.

BACKGROUND AND PURPOSE: Neuroradiology has become an increasingly diverse and subspecialized discipline. We evaluated the current status and trends affecting fellowship programs and the practice of clinical neuroradiology at academic medical centers, with emphasis on invasive procedures. METHODS: All 85 program directors at Accreditation Council for Graduate Medical Education-approved fellowships in neuroradiology were sent a detailed questionnaire pertaining to various demographic aspects of their program and the performance of certain radiologic examinations of the brain and spine. RESULTS: Sixty-seven programs (79%) responded. As many as 50% of programs are 1 year in length. Twenty-five percent of 2-year fellows leave their program after 1 year of training. During the past 5 years, 36% of programs have decreased in size and 73% reported a decline in the number of applicants. The majority (55%) of programs have had applicants renege on their commitment to begin a fellowship. Twenty percent of 2-year programs do not offer training in endovascular interventional procedures. Neurosurgeons perform endovascular interventional procedures at 18% of centers. There is an 18-fold variation in the volume of neuroangiographic procedures performed each year and a 150-fold variation in the volume of myelographic procedures performed. In 29% of programs, neuroradiologists are nonparticipants in nonvascular interventional spinal procedures; in 40%, they share these procedures with musculoskeletal radiologists/nonradiologists. CONCLUSION: Interest in fellowship programs in neuroradiology is declining. An applicant's commitment to either begin a fellowship or complete 2 years of training cannot be regarded with assurance, and there is a lack of uniformity in many areas of the training experience, particularly in invasive diagnostic and therapeutic procedures.     

Impact of the Professional Component MPPR Policy on Interdivisional Finances in an Academic Radiology Department

PurposeThe professional component (PC) Multiple Procedure Payment Reduction (MPPR) policy reduces reimbursement for two or more imaging services rendered by the same group practice for a single patient in a single session. The purpose of this study was to analyze the impact of the PC MPPR on interdivisional finances in an academic radiology department.MethodsA retrospective analysis of Medicare collections from imaging services rendered by a single academic radiology department in a tertiary care medical center for calendar year 2014 was performed. The impact of the PC MPPR on each division was calculated as the fraction of the total departmental PC MPPR, and as the proportion of the divisional revenue.ResultsThe total decrease in Medicare collections as a result of the PC MPPR was 5.35%. The impact of the PC MPPR on each division as a fraction of the total departmental PC MPPR was: abdominal division (16.63%); thoracic division (23.56%); breast division (0.03%); musculoskeletal division (11.92%); neuroradiology division (34.40%); and noninvasive cardiovascular division (13.46%). The impact of the PC MPPR on each division as a fraction of the divisional revenue was: abdominal (2.82%); thoracic (11.83%); breast (0.66%); musculoskeletal (6.01%); neuroradiology (5.31%); and noninvasive cardiovascular (5.85%).ConclusionsThe PC MPPR differentially affects divisions within an academic radiology department. The neuroradiology and thoracic divisions of our department were the most adversely affected, owing to the high frequency of combined examinations. We speculate that this impact has implications for divisional self-sufficiency, interdivisional relationships, and resident decision making regarding subspecialty training.     

eLearning in education and advanced training in neuroradiology: introduction of a web-based teaching and learning application

Introduction New information technologies offer the possibility of major improvements in the professional education and advanced training of physicians. The web-based, multimedia teaching and learning application Schoolbook has been created and utilized for neuroradiology.Methods Schoolbook is technically based as a content management system and is realized in a LAMP environment. The content is generated with the help of the developed system and stored in a database. The layout is defined by a PHP application, and the webpages are generated from the system.Results Schoolbook is realized as an authoring tool so that it can be integrated into daily practice. This enables the teacher to autonomously process the content into the web-based application which is used for lectures, seminars and self-study. A multimedia case library is the central building block of Schoolbook for neuroradiology, whereby the learner is provided with original diagnostic and therapeutic data from numerous individual cases. The user can put individual emphasis on key learning points as there are various ways to work with the case histories. Besides the case-based way of teaching and learning, a systematically structured way of dealing with the content is available.Conclusion eLearning offers various opportunities for teaching and learning in academic and scientific as well as in economic contexts. Web-based applications such as Schoolbook may be beneficial not only for basic university education but also for the realization of international educational programmes such as the European Master of Medical Science with a major in neuroradiology.     

Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs

PurposeTo describe resident-reported experience in brachytherapy in Accreditation Council of Graduate Medical Education–accredited radiation oncology training programs over the last 5 years.Methods and MaterialsArchived reports of Accreditation Council of Graduate Medical Education final resident case logs from the last 5 years were reviewed and summarized. Brachytherapy was categorized according to the dose rate (low dose rate vs. high dose rate), technique (interstitial vs. intracavitary), and primary tumor site. Linear regression was used to test for trends.ResultsThe mean number of total brachytherapy procedures performed per resident in the last 5 years has decreased from 80.8 in 2006–2007 to 71.0 in 2010–2011, but the trend is not statistically significant. The average number of intracavitary procedures has remained steady. The average resident experience with interstitial brachytherapy has decreased in a statistically significant manner. The average number of interstitial procedures has decreased by 25%.ConclusionsThe average number of interstitial procedures reported by residents has decreased by 25%. The community charged with training residents in interstitial brachytherapy should consider methods to ensure that residents obtain sufficient experience in the future.